Galore International Journal of Health Sciences and Research

Vol.1; Issue: 1; Dec. 2016

Website: www.gijhsr.com
Original Research Article P-ISSN: 2456-9321

Role of Discharge Summary in Delayed Discharge Process

Roopjot Kochar

Ayurvedic Physician and Nutritionist, 78/13 Anant Nagar, Khanna-141401

________________________________________________________________________________________________________________

ABSTRACT patient is deemed to be medically well

Delays in the discharge of hospital patients
cause a backlog for new admissions from the
Emergency Departments, outpatient clinics, and
transfers from the Intensive Care Units. A
variety of initiatives have been reported on
previously which aim to tackle this problem
with variable success. While hospital
administrators encourage the discharge of
patients in the morning to expedite flow through
the hospital, often discharges are clustered in the
afternoon creating a mismatch between demand
and availability of beds in the morning. This
mismatch can cause significant overcrowding in
the Emergency Department and will affect
transfers from Intensive Care Units and elective
admissions. The present study has been
conducted on 270 patients admitted at a
multispecialty hospital of Ludhiana to
understand one of major cause of delay in
discharge process is delayed preparation of
discharge summaries. Turnaround time was
recorded from discharge intimation to final
summary signed by concerned doctor in order to
calculate and study the cause of delay. The
present study findings show that majority are
taking 3-5 hrs time between discharge
intimation and final summary indicating delayed
discharge process.
Keywords: Discharge Process, Discharge
Intimation, Delay in Discharge, Final Summary,
Turnaround Time
INTRODUCTION AND REVIEW OF
LITERATURE
Delayed discharge or ’bed blocking’
are terms used to describe the inappropriate
occupancy of hospital beds. Discharge
delays due to lack of availability of post-
discharge facilities and waiting for
consultant opinions, tests and procedures,
have been identified previously. [1] Delayed
discharge refers to the situation where a
enough for discharge but where they are
unable to leave hospital because
arrangements for continuing care have not
been finalized. [2] The problem of delayed
discharges in the UK is identified as a
system-level issue, leading to inefficiencies
in acute bed usage. Discharging patients
from the hospital is a complex process that
is fraught with challenges and involves over
35 million hospital discharges annually in
the United States. Among Medicare
patients, almost 20 percent who are
discharged from a hospital are readmitted
within 30 days, and the cost of unplanned
readmissions is 15 to 20 billion dollars
[3]
annually. Preventing avoidable
readmissions has the potential to profoundly
improve both the quality of life for patients
and the financial wellbeing of health care
systems. Discharge planning is the
development of an individualized discharge
plan for the patient, prior to leaving the
hospital, to ensure that patients are
discharged at an appropriate time and with
provision of adequate post-discharge
services. Such planning is a mandatory part
of hospital accreditation. [4]
Discharge planning is a complex
process that seeks to determine the
appropriate level of services required by the
patient and then match the patient to an
appropriate site of care. [4] This process
ideally begins at the start of the
hospitalization. The hospital case manager
should be involved as soon as it is clear that
the patient will require services at home or
transfer to an alternative level of care. The
decision to discharge a patient from a
hospital is a complex process governed by
many factors, which comprise not only
medical but also organizational reasons, and

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 25

Vol.1; Issue: 1; December 2016
 Roopjot Kochar. Role of Discharge Summary in Delayed Discharge Process

not all of which are easily controlled. It has present study has been planned to study the
been estimated that approximately 30% of role of discharge summary in discharge
hospitalized patients experience a delay of process.
their discharge, while about 30% of these
delays are due to non-medical factors. [5] METHODOLOGY
The primary mode of The present study has been carried
communication between the hospital care out on 270 discharged patients from
team and aftercare providers is often the different wards of different departments to
discharge summary, raising the importance study the discharge process timings in a
of successful transmission of this document multispecialty hospital of Ludhiana. Time
in a timely fashion. Unfortunately, the taken from discharge intimation to final
discharge summary reaches the primary care summary by different doctors was recorded
provider by the time of the first follow-up to study one of the main causes of delayed
visit in only 12 to 34 percent of such visits, discharge process i.e. delay in preparation of
and even then often lacks key information. final summary.
One large, single-center, retrospective study
found that a delay in completion of the RESULTS AND DISCUSSION
discharge summary was associated with NEPHROLOGY
higher rates of readmission. [6] There was an
increase in readmission if the discharge P
12

summary was not completed within three A 10

N
days after discharge (odds ratio [OR] 1.09, T 8
O
95% CI 1.04-1.13) and the risk continued to I
6 12
E
increase for every additional three days to O 8
N 4
complete the discharge summary. At the F
T 4
time of discharge, the patient should be S
2 3
provided with a document that includes 0
1 ( below 1 2 ( between 3 (between 3- 4 (between 5-
language and literacy-appropriate hour) 1-3 hours) 5 hours) 7 hours)

instructions and patient education materials

DISCHARGE INTIMATION TO FINAL SUMMARY
to help in successful transition from the (TIME )
hospital. These documents should be brief,
Figure 1 : Total Time Taken During Discharge
focused on critical information to the Intimation to Final Summary in Nephrology
patient, and primarily directed at what the Department
patient needs to understand to manage his or
her condition after discharge. Thus, the
SURGERY

30
25
P
20
A
N 29
T 15
O
I 10 20
E
O 5 7
N 3 2 2
F 1
T 0
1 ( below 1 2 ( between 1- 3 (between 3-5 4 (between 5-7 5 (on brief) 6 (Advance 7 Discharge
S hour) 3 hours) hours) hours) summary) intimation and
final summary
at same time

DISCHARGE INTIMATION TO FINAL SUMMARY (TIME)

Figure 2 : Total Time Taken During Discharge Intimation to Final Summary in Surgery Department

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 26

Vol.1; Issue: 1; December 2016
 Roopjot Kochar. Role of Discharge Summary in Delayed Discharge Process

It is shown from figure 1 that in It is observed from figure 3 that time

nephrology department discharge intimation taken for maximum no. of patients (24) is
to final summary time taken for maximum observed between 1-3 hrs for final summary
no. of patients i.e 12 has been observed to followed by 6 patients each between 3-5 hrs
be 3-5 hrs followed by 8 patients between 1- and below 1 hour, 4 pateints were recorded
3 hrs and for 4 pateints it has been recorded to be on brief summary and 3 on advance
to be below 1 hr while for 3 pateints time summary in medicine department.
taken between discharge intimation to final It is observed from figure 4 that in
summary has been found to lie between 5-7 neurology department time taken for
hours. maximum no of patients 3-3-3 has been
It is observed from figure 2 that in observed between 1-3 hrs, between 3-5 hrs,
surgery department time taken for between 5-7 hrs and for 2 patients it was
maximum no. of patients i.e 29 has been recorded below 1 hour.
observed between 1-3 hrs for final summary
followed by 20 patients between 3-5 hrs and
GYNAECOLOGY
7 below 1 hr, 2 patients were on brief
summary detail and another 2 patients have 14
12
been on advance summary and 1 patient had P
10
no time gap between discharge intimation N
A
and final discharge summary. T 8 14
O 6
I
9
E 4
O
MEDICINE N 2
F 1 2
T 0
30 S 1 ( below 1 2 ( between 3 (between 4 (between
P hour) 1-3 hours) 3-5 hours) 5-7 hours)
A 20
N
T
O 24 DISCHARGE INTIMATION TO FINAL SUMMARY
I 10
TIME
E 6 6
O 3 4 Figure 5 : Total Time Taken During Discharge Intimation to
N 0 Final Summary in Gynaecology Department
F
T
S
It is observed from figure 5 that time
taken for maximum no of patients 14 has
DISCHARGE INTIMATION TO FINAL SUMMARY been observed to be 1-3 hrs in gynaecology
TIME department followed by 9 patients between
Figure 3 : Total Time Taken During Discharge Intimation to
3-5 hrs and 2 patients between 5-7 hrs.
Final Summary in Medicine Department

GASTROENTEROLOGY
NEUROLOGY
40
3
P 30
2.5 P
A
N 2 A 20
T N
O 3 3 3 T 31
I 1.5 O
E I 10
1 2
O E 6 8
N O 2
F 0.5 N 0
T F 1 ( below 1 2 ( between 3 (between 3 (Advance
S 0 T hour) 1-3 hours) 3-5 hours) summary)
1 ( below 1 2 ( between 3 (between 4 (between S
hour) 1-3 hours) 3-5 hours) 5-7 hours)

DISCHARGE INTIMATION TO FINAL SUMMARY DISCHARGE INTIMATION TO FINAL SUMMARY

TIME TIME

Figure 4: Total Time Taken During Discharge Intimation to Figure 6 : Total Time Taken During Discharge Intimation to
Final Summary in Neurology Department Final Summary in Gastroenterology Department

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 27

Vol.1; Issue: 1; December 2016
 Roopjot Kochar. Role of Discharge Summary in Delayed Discharge Process

Figure 6 reveals that time taken for It is observed from figure 9 that time
maximum no. of patients i.e. 31 has been taken for maximum no of patients 17 is
observed between 1-3 hrs for final summary observed between 1-3 hrs for final summary
followed by 8 patient between 3-5 hrs, 6 followed by 5-5 patients each below 1 hr
below 1 hr and 2 pateints were on advance and on advance summary, 3 patients
summary in gastroenterology department. between 3-5 hrs, 1-1 each between 5-7 hrs
and on brief summary respectively in
paediatrics department.
UROLOGY
4
PAEDIATRICS
3.5
P 3 20
A 2.5
N P 15
T 2 4
O A
I 1.5 N 10
T 17
E 1 2 2 O
O I
N 1 1 5
F 0.5 E 5 5
T O 3 1 1
0 N 0
S 1 ( below 1 2 ( between 3 (between 4 (between 5 (Advance F
hour) 1-3 hours) 3-5 hours) 5-7 hours) summary ) T
S
DISCHARGE INTIMATION TO FINAL SUMMARY
TIME
Figure 7 : Total Time Taken During Discharge Intimation to DISCHARGE INTIMATION TO FINAL SUMMARY
Final Summary in Urology Department TIME
Figure 9 : Total Time Taken During Discharge Intimation to
Final Summary in Paediatrics Department
It is observed from figure 7 that time taken
for maximum no of patients 4 is observed
CARDIOLOGY
below 1 hr for final summary followed by 2
-2 patients between 3-5 hrs and 5- 7 hrs, 1-1
between 1-3 hrs and on advance summary P 3

resceptively in urology department . A 2.5

N
T 2
O 3 3
I 1.5
ENT E
O 1
N
F 0.5
T
S 0
P 1 ( between 1-3 2 (between 3-5
A 5 hours) hours)
N
T 4
O
I DISCHARGE INTIMATION TO FINAL SUMMARY
3 5
E TIME
O
N 2 Figure 10 : Total Time Taken During Discharge Intimation to
F
T Final Summary in Cardiology Department
1
S
0
1 It is observed from figure 10 that
time taken for 3 patients has been observed
DISCHARGE INTIMATION TO FINAL SUMMARY
TIME
between 1-3 hrs and for another 3 patients it
Figure 8 : Total Time Taken During Discharge Intimation to has been recorded as 3-5 hrs in cardiology
Final Summary in ENT Department department.
Figure 8 shows that the time taken for CONCLUSIONS
maximum no. of patients i.e. 5 in ENT Thus, it can be concluded that
department has been observed between 1-3 maximum time i.e. between 5-7 hours has
hrs for final summary. been taken between discharge intimation to

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 28

Vol.1; Issue: 1; December 2016
 Roopjot Kochar. Role of Discharge Summary in Delayed Discharge Process

final summary in nephrology, neurology,
gynecology, pediatrics, urology departments
which indicate delay in discharge process.
Majority of patients (12) in nephrology
department had delayed discharge due to
extended discharge intimation to final
summary time of 3-5 hrs while good
number of patients in other departments
including surgery , medicine, gynecology
and gastroenterology also had 3-5 hrs of
discharge intimation to final summary time
indicating it to be one of the major causes of
delayed discharge.
REFERENCES
1. Muhammad Umair Majeed et al. Delay
in discharge and its impact on
unnecessary hospital bed occupancy.
BMC Health Services Research 2012;
12: 410.
2. Karen Bryan; Policies for reducing
delayed discharge from hospital. Br
Med Bull 2010; 95 (1): 33-46.
3. Jencks SF, Williams MV, Coleman EA.
Rehospitalizations among patients in the
Medicare fee-for-service program. N
Engl J Med 2009; 360:1418.
4. Shepperd S, McClaran J, Phillips CO,
et al. Discharge planning from hospital
to home. Cochrane Database Syst Rev
2010; CD000313.
5. Ubbink DT, Tump E, Koenders JA,
Kleiterp S, Goslings JC, Brölmann FE.
Which Reasons Do Doctors, Nurses,
and Patients Have for Hospital
Discharge? A Mixed-Methods Study.
PLoS ONE. 2014; 9(3): e91333.
6. Hoyer EH, Odonkor CA, Bhatia SN, et
al. Association between days to
complete inpatient discharge summaries
with all-payer hospital readmissions in
Maryland. J Hosp Med 2016; 11:393.
How to cite this article: Kochar R. Role of
discharge summary in delayed discharge
process. Galore International Journal of Health
Sciences & Research. 2016; 1(1): 25-29.

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Galore International Journal of Health Sciences and Research (www.gijhsr.com) 29

Vol.1; Issue: 1; December 2016